I say this in my non-nurse life. If you don’t vote, you can’t complain.

This means for president or senate or anything else.

This also includes for state boards of nursing.

I always vote for the nursing officers for the state.

These are the people who will be representing us to the rest of the nation and they are important.

And my pager just went off.

I have to go reduce a hip.

I will finish this thought later.

I know I’ve been in healthcare for 20+ years but loss is inevitable.

I have lost patients.

I have lost coworkers.

I have lost favorite doctors.

And I don’t mean to retirement, although that happens.

Or to going to another job because the OR is full of job hoppers.

I’ve taken care of a lot of people I work with.

Anesthesiologists, nurses, techs, friends and family of all of the above.

And I’ve experienced a lot of loss.

But this last six months we’ve lost a wonderful anesthesiologist.

He was amazing with patients.

He would always joke about the breast enlargement for male patients.

He was gentle with children.

And with parents.

And with patients.

And with nurses and techs and other doctors.

He knew when to say no to a surgeon before they wanted to do a dangerous case.

And he died after a very brief illness.

That is the best ending I could hope for him.

I just wish he’d been in the world a little longer.

Last week was rough.

My boss added it up for me:

One nurse left.

One of the travelers left.

The other traveler was not suited to our fast-paced OR and left.

One nurse was out on FMLA.

Two nurses were on vacation.

SIX nurses down, out of 16 is a lot of man hours that need to be covered.

And last week was uncommonly busy.

I added 4 cases a night.

Plus the three or so that came in during the day.

All the hours were worked.

Oof, no wonder I napped all the naps today.

I heard from another tech that my weekend tech claimed to work 18 hours call back this weekend.

Um, no.

We worked an hour and a half on Saturday.

Well, I worked two but I was there 40 minutes before he waltzed in.

He was there at 1100 on Sunday and he should have left after it was determined there would be a 3 hour lag before the first case while the instruments were sterilized.

Don’t ask me what they were doing.

We finished at 1830.

I went in at 1430 and got the case started and finished.

There was an appy (there very nearly always is) and that took 2 hours.

Okay. I went and looked at my hours for this weekend. Saturday I was there 2.5 hours but I was there way before him.

Sunday, I worked from 1430-1900, which is 4.5 hours.

And 2146-2349. This is two hours.

This marks me 9 hours at call back.

He was there during the day shift before me.

But still, the numbers don’t add up.

And no matter what I am doing after the case, department related, scheduling cases, etc., he’s always “leaving” when I have changed and I am about to leave, even if I saw him “leaving” a good thirty minutes ahead.

My only conclusion is that he is milking the time clock.

Which is fraud.

And one of the rule violations that will get you fired immediately.

This is a very serious accusation.

I need more data.

I do not find it easy to make friends.

My sister says I look severe, although I am not when you get to know me.

RNF I call it.

Resting Nurse Face.

However, I find it easy to be friendly with my coworkers.

I find it easy to make conversation, to ask about their children and their spouses.

And sometimes I make enemy is the wrong word.

Let’s just say people who don’t care for me.

I tell the truth, even if they don’t want to hear it.

I expect them to work, even if they don’t want to.

I no longer expect them to do the same caliber of job that I do.

Because their top caliber may be different than mine.

I can be brief when I’m tired.

I can be cranky too.

But that’s okay.

When you are called in you have 30 minutes to get to the hospital.

Not 40.

Not 50.

Not 60.

Thirty, 30, 3-0.

Do not pass go, do not shower, do not go out to eat, do not walk the dog.

Unless you can get it done and still report to the hospital within the 30.

I think people have gotten spoiled because I live so close to the hospital.

I’m there usually within ten, fifteen with traffic.

This leaves me time to grab and sign into a phone.

Schedule the case.

Pick the case.

Call for report for patient.

Arrange transport for patient.

Put the pick in the room.

Pre-op the patient.

Tell anesthesia the patient is in PACU.

And you are still not there.

That’s assuming you’ve answered your phone at all.

If not, and this has happened several times recently with a certain tech, I start the phone tree looking for a replacement tech.

And I stall the doc until a tech arrives, without letting on that we are waiting for a tech.

It’s getting old, people.

Um, so I was rounding to make sure the rooms were picked up and the stirrups away and the rooms set back to neutral when I noticed a nurse was still in the department.

She was cleaning and organizing room 5.

She’d spent a bulk of the day cleaning and organizing room 6 for the advent of cases.

She asked me to approve of her changes and I did.

In room 6.

In room 5 she put unsterile specimen containers above the computer in the computer station.

Because the room might need them.

I looked past her to the substerile room that was 1 door and 5 feet away and asked, “Like the ones in the substerile cabinet. That is 5 feet away.”

She said yes, and sometimes people didn’t like to leave their rooms.

I repeated, “5 FEET away is too far?”

She didn’t speak to me the remaining 4 minutes of her shift.

I felt like the little kid who was collecting money for the newspaper and all he wanted was 2 dollars.

Sheesh.

Five feet away and it is too far to walk.

I thought I was done with this since I left California.

But no!

My hospital is tightening the proverbial belt around budgets.

I have no quarrel with this.

I have no objection.

What I do object to is cutting the staffing so deep that we only have enough people to do the cases.

That means nothing gets stocked.

That means nothing is checked for expiration date.

That means we are running cases until the wee hours of the morning because they told anesthesia that of course they could run five rooms that day, not six and the add-ons backed up.

This leaves evening shift to not only clean up after days, but to run the rooms until way past dark.

I am tired.

It was decided that my OR would add a weekend shift.

0700-1900.

A nurse and a tech and Pacu team too.

We’ve hired the tech.

There hasn’t been a good fit for the RN role.

But the tech has been training during the week on the evening shift.

And tonight I laid it all out for her.

How to prioritize cases.

How to get an emergency case done.

What kind of emergency cases that are done in our OR.

How to utilize the laser call person.

How to find out information that is needed.

Because her orientation will be over.

And, until she has a nurse, she’ll have to forge ahead.

She is motivated.

I think she’ll do fine.

Time has a funny way of affecting a budget.

Not only return on investment.

Not only asset capture.

Not only surgical time versus man hours.

But the expiration of surgical supplies.

These can be many things.

Sponges.

Mesh implants.

All the implants.

Dressings.

Staplers.

Suture.

The list is as long as the supplies for the OR.

99.9% of our supplies/implants have an expiration date.

If the department doesn’t use them within the time frame, the department eats the cost.

I am sure some of the depreciation is calculated into the cost of surgery.

But.

I train people to always look at expiration dates when opening supplies.

Most especially for implants.

And if there are two of an item in their hand, they should open the one that will expire first.

It just makes sense.